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Adventures in Medical Travel

Americans head overseas for five-star care at Motel 6 prices.

August 31, 2007

Returning from vacation with a tummy tuck and a tan isn't unusual anymore. But a flat stomach and a face untouched by time aren't the only physical improvements people are seeking abroad. A growing number of patients head overseas for more-serious procedures, such as hip replacements, heart bypasses and kidney transplants.

Why travel halfway around the world for a medical procedure? Because you could pay a fraction of what you'd pay in the U.S. A hip replacement stateside can run between $44,000 and $63,000, versus about $12,000 to $18,000 abroad, even with travel and hotel costs included. Prices vary depending on your destination and the type of surgery, but it isn't unusual to save as much as 80%.

Greg Scandlen, president of Consumers for Health Care Choices, says the best candidates for overseas treatment are individuals who lack health insurance or have high-deductible health plans. People who are uninsured "pay out of their own pocket regardless of where the surgery takes place," says Scandlen.

And as the number of people who have high-deductible policies paired with health savings accounts continues to grow, many patients are becoming more cost-conscious. You can use money in an HSA tax-free to pay for overseas medical and surgical procedures that qualify under IRS rules.

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Deluxe accommodations

Skeptical about going abroad for medical care? The truth is that foreign hospitals often rival or surpass those found in the U.S. Jonathan Edelheit, vice-president of insurance group OptiMed Health/United Group Programs, draws an analogy between five-star hotels and Motel 6 -- with U.S. hospitals more like Motel 6. "Overseas hospitals are often nicer than ours, and their equipment is as good or better, as are their doctors, many of whom trained in the States before going overseas," he says. "The average American has the impression that we have the world's best health care. But it's possible to find better care over there than you would get here."

No doubt Michael Hornholtz would agree. After having surgery to straighten a broken nose in 1974, Hornholtz, now 66, experienced chronic nerve pain. For years he searched for a doctor who would correct the problem, but no one would touch his case for fear of getting involved in malpractice litigation. After Hornholtz's current insurer, Kaiser Permanente, rejected two recent appeals, someone suggested that he might have better luck abroad.

Hornholtz contacted PlanetHospital, a medical-tourism company. PlanetHospital (800-243-0172; www.planethospital.com) found him a doctor in Singapore who would perform nasal surgery to repair the nerve damage. The company made his travel arrangements and had a staff member tend to him from the time he landed in Singapore until he returned home.

Two weeks after his surgery, Hornholtz was thrilled with the outcome. "After 33 years of living with chronic pain, I'm enjoying a restoration of sanity," he says. He can now breathe easily and no longer needs the sleep-apnea monitor he used for years. Because Hornholtz couldn't find a surgeon in the U.S., price wasn't an issue. But, he says, the total cost, which he estimates was about $12,000, was well worth it. Hornholtz paid all his expenses directly to the providers, from the travel arrangements to the hospital and doctor. PlanetHospital charged a $395 concierge fee.

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Check credentials

When Rudy Rupak founded PlanetHospital in 2002, a Google search for medical tourism generated two hits -- his company and an outfit in Iran. Today there are dozens of medical-tourism Web sites. PlanetHospital, says Edelheit, has the distinction of being one of the good guys. That's because all of its hospitals agree to a protocol that obligates the hospital to take care of the patient if a surgery needs to be redone. Rupak is also working with an insurer to provide indemnity coverage for partner hospitals against negligence and malpractice later this year.

If you intend to go overseas for medical care, first check the credentials of both the hospital and the doctors who will treat you. Rupak says that most surgeons PlanetHospital chooses are trained or board-certified in the U.S., and that most of its hospitals are certified by the Joint Commission International or are in the process of applying for certification. JCI is the international arm of the Joint Commission on Accreditation of Healthcare Organizations, the major U.S. accreditation body. If you're making arrangements on your own, call the hospital and ask whether it is JCI-accredited. If you're working with a medical-tourism company, make sure that the hospital recognizes the company and that the company has inspected the hospital.

Scandlen cautions that in most cases you'll have no liability protection or recourse in case of malpractice. And after-care often isn't addressed. He speculates that if overseas health care becomes common, more providers will start to pay voluntarily for liability coverage. He also suggests that networks of homegrown doctors affiliated with overseas hospitals could solve the issue of follow-up care after a patient has returned to the U.S.

As medical tourism grows, so does transparency in health-care costs. "The most exciting part of this is that it's challenging American hospitals to rethink the way they do business," says Scandlen.